Apparatus for use in mouth-to-mouth resuscitation



Nov. 23, 1965 G. BARTLETT, JR 3,219,030

APPARATUS FOR USE IN MOUTH-TO-MOUTH RESUSCITATION Filed Feb. 9, 1962 2Sheets-Sheet l INVENTOR. Roscoe G. Bartlett, Jr.

Attorney Nov. 23, 1965 R. G. BARTLETT, JR 3,219,030

APPARATUS FOR USE IN MOUTH-TO-MOUTH RESUSCITATION Filed Feb. 9, 1962 2Sheets-Sheet 2 INVENTOR. Roscoe G. Bartlett, Jr.

v Attorney 3 United States Patent 3,219,030 APPARATUS FOR USE INMOUTH-TO-MOUTH RESUSCITATION Roscoe G. Bartlett, Jr., US. Navy School ofAviation Medicine, Pensacola, Fla. Filed Feb. 9, 1962, Ser. No. 172,3596 Claims. (Cl. 128-29) (Granted under Title 35, US. Code (1952), sec.266) The invention described herein may be manufactured and used by orfor the Government of the United States of America for governmentalpurposes without the payment of any royalties thereon or therefor. Thepresent invention relates generally to apparatus for aiding victims ofrespiratory failure and, more particularly, to apparatus for emergencyuse in the so-called mouth-to-mouth resuscitation method where air isforced directly into the patients lungs in an effort to restore theseorgans to their normal operation.

In the mouth-to-mouth resuscitation method, the individual endeavoringto assist the party whose respiratory system has been temporarilydisabled may be required to establish physical contact between his mouthand that of the patient. Because of this intimacy, there is anunderstandable reluctance on the part of some people who otherwise arein a position to render help to such victims to participate in this formof first aid. Moreover, during the resuscitation attempt, fluids may bedischarged from the mouth of the victim and further repel theinexperienced operator, causing him to interrupt or discontinue hisefforts. Besides these unpleasant features, the close physical contactrequired by this technique may be harmful to the operator should thepatient be suffering from a communicable disease.

It is therefore a primary object of the present invention to provideapparatus for use in mouth-to-mouth resuscitation wherein physicalcontact between the parties is avoided.

A still further object of the present invention is to provideresuscitation apparatus for use in the so-called mouth-to-mouth methodwherein the operator is protected from contamination by the patientsexpired breath.

Another object of the present invention is to provide apparatus for usein mouth-to-mouth artificial respiration wherein the operators and thevictims respiratory systems are isolated except during the times theoperator is exhaling into the victimslungs.

A yet still further object of the present invention is to provideapparatus for use in mouth-to-mouth resuscitation wherein there is nointerference between the operators normal breathing cycle and that ofthe patient.

A still further object of the present invention is to provide apparatusfor use in artificial respiration which provides positive ventilation ofthe victim.

A yet still further object of the present invention is to provide asimple and inexpensive device for positive artificial ventilation of avictim of respiratory failure wherein the operator need not remove hismouth from the device during the treatment.

Other objects and many of the attendant advantages of this inventionwill be readily appreciated as the same becomes better understood byreference to the following detailed description when considered inconnection with the accompanying drawings wherein:

FIG. 1 schematically depicts an offset piston-type resuscitation deviceconstructed according to one form of the present invention;

FIG. 2 shows one form of a simple, non-loaded check valve assembly foruse in the apparatus of FIG. 1;

FIG. 3 schematically illustrates an offset bellows-type of resuscitationdevice;

3,219,030 Patented Nov. 23, 1965 FIG. 4 shows an in-line, piston-typeconstruction; and

FIG. 5 shows an in-line, bellows-type of resuscitation apparatus.

Referring now to FIG. 1 of the drawings, a simplified, piston-typeresuscitation device, constructed according to one preferred embodimentof the present invention, is seen to comprise a substantially T-shaped,tubular housing 1 having a pair of vertical mouthpiece sections 2 and 3,slightly offset from each other, and a pair of horizontally alignedintake and exhaust sections 4 and 5 intersecting therewith. Section 4,the air intake line, communicates at one end thereof with section 2, theoperators mouthpiece end, Via a normally closed, non-loaded check valve6. This valve, which is of conventional design, as best shown in FIG. 2,includes a circular frame 7 having an outer ring 8 and an inner ring 9concentrically mounted therein by a group of radial spokes 10. Thisframe, it will be appreciated, is mounted in the location shown by anysuitable means. Cooperating with this member is a flexible,crescent-shaped diaphragm 11 which has a central ball projection 12extending from one side thereof. As is well known, this ball can beforced through the central aperture 13 in inner ring 9 from either sidethereof to form a complete check valve assembly. It would be noted atthis time that the valve opens only when the pressure acting on side 10of the diaphragm 11 exceeds that on the other side of this element.Thus, in the apparatus of FIG. 1, check valve 6, which is normally keptclosed by the shape and resiliency of its diaphragm, opens only when thepressure on the left-hand side thereof exceeds that on the right-handside, a condition which, it will be seen, occurs only during theinhalation part of the operators breathing cycle. The intersecting areaof sections 2 and 4 communicate with that of 3 and 5 via a second checkvalve 15 whose construction is the same as that of valve 6. The formervalve is likewise normally closed, opening only when the pressure on theleft-hand side thereof is greater than that on the right-hand side, acondition which, it will be seen, occurs only during the exhalation partof the operators breathing cycle.

The operators mouthpiece section 2 and the exhaust section 5 are alsointerconnected via a pressure-sensing tube 16 which terminates atopposite ends thereof in apertures 17 and 18 formed in the side walls ofthese sections. Section 5 is closed off at end 19 and accommodatedtherein is a piston 20 which is biased by a helical spring 21 up againstan annular, sealing shoulder (or valve seat) 22 formed in the inner wallof this section at an intermediate point between exit ports 24 and 25and the victims mouthpiece section 3. It will thus be seen that piston20 normally blocks exit ports 24 and 25 which vent the exhaust section.

The operation of the apparatus just described is as follows: Afterappropriate safeguards have been taken to insure the existence of anunobstructed passageway into the patients lungs, the free end ofmouthpiece section 3 is inserted into the patients mouth and hisnostrils pinched tight. The operator then places his mouth over hismouthpiece section 2 and commences to breathe deeply at, perhaps, aslightly accelerated rate. During the inhalation part of his breathingcycle, air is drawn into inlet section 4 through intake check valve 6and via his mouthpiece section 2 into hisrespiratory system, followingthe path shown by dashed arrows 26. During the exhalation part of thecycle, his discharge passes down through section 2, check valve 15 nowopen, mouthpiece section 3 and into the patients lungs, following thepath shown by dashed arrow 27. Intake valve 6 stays closed at this timebecause of the increased pressure acting on the right-hand side of itsdiaphragm. Although there is an increased pressure acting on theleft-hand end of piston 20 during this air transfer period, thiscomponent remains substantially stationary because of the counteractingpressure applied via tube 16 to its opposite side and the bias of spring21. Consequently, exit ports 24 and 25 remain closed and none of theexhaled air escapes into the atmosphere via these openings. It would bepointed out at this time that the inside diameter of exhaust section 5is made slightly larger than the outside diameter of piston 20. Thisrelationship permits tubular section 5 to perform as the pistonscylinder to insure the latters free displacement therein. At thecompletion of the operators expiration, the elastic recoil of thepatients chest and lungs acts to discharge the air previously forcedinto his system back into his mouthpiece section 3. This flow maintainscheck valve closed and, in doing so, isolates the operators system fromthat of the patient during this critical period.

During this discharge period, the operator prepares for the next airtransfer operation by drawing air into his system, the air flow beingvia the path previously identified. As the operator inhales for thisnext breathing cycle, a negative pressure is created at the right-handside of piston because of the pressure-sensing tube connection to theoperators mouthpiece. It would be pointed out that since check valve 15is closed at this time the condition of counteracting pressuresencountered during the operators exhalation effort cannot occur. Sincethere is now a greater pressure on the left-hand side of piston 20, thiscomponent moves to the right against the slight biasing force of spring21 and opens ports 24 and 25, thereby establishing a path to theatmosphere for the patients discharge, this path being represented bydashed arrow 28. Thus, the patients expiratory airway is opened by theoperators inhalation. This feature facilitates expiration in patientswith poor elastic recoil of chest and lungs.

The sequence above described is repeated throughout the resuscitationattempt, with the operator breathing normally without interference fromthe patient, and the patient, in turn, receiving his exhalations andthereafter subsequently discharging this air into the atmosphere whilethe operator is drawing his next breath. It will be seen from the abovethat, not only are patient and operator physically separated by theintervening apparatus of FIG. 1, but that their respiratory systems aremutually coupled only during that portion of the cycle during which theoperator is exhaling into the patients lungs. As a result of this, thereis little danger of the operator being contaminated by air dischargedfrom the patients system. Moreover, the isolating action of check valves6 and 15 permit the operator to satisfy his own breathing demandswithout removing his mouth from his mouthpiece.

In FIG. 3 there is shown an alternative construction wherein thevertical, tubular sections and 31 corresponding to the operators and thepatients mouthpieces, respectively, are coaxially disposed to facilitatethe unimpeded flow of air to the patient during the operatorsexhalation. Tubular section 32, the intake line, again terminates nearone end thereof in a check valve 33 similar in construction to itscounterpart 6 in the modification of FIG. 1. However, the second checkvalve, valve 34 in this configuration, is positioned across diagonalcorners of the intersection formed by the mouthpiece sections 30 and 31and the intake and exhaust sections 32 and 35. This valve, like itscounterpart 15 in FIG. 1, is normally closed and opens only when air isbeing delivered to the patient. Horizontal section 35, the exhaustpassageway, is again coupled to the operators mouthpiece 30 via apressure-sensing tube 36 but, instead of retaining a piston forselectively opening exit ports 37 and 38, this section houses a checkvalve 39 and a cooperating bellows 40 which together carry out the sameventing function. To accomplish this, check valve 39 is positionedadjacent the open end of section between the exhaust ports and theintersection above defined. One end of bellows is secured to an innerwall portion 41 of section 35 located between the above ports and oneend of tube 36. The other end of this bellows contacts a rim portion ofdiaphragm 42 of check valve 39. It will thus be seen that the abovediaphragm, in effect, seals one end of the bellows and precludes any ofthe operators discharge from reaching the exit port via valve 39.

It will be appreciated from an inspection of this apparatus that checkvalves 33 and 34 duplicate the performance of valves 6 and 15 in themodification of FIG. 1, opening the intake line during the operatorsinhalation effort and opening an air passageway to the patient duringthe operators exhalation effort. The first valve of this pair alsoprevents the operators discharge from being expended into theatmosphere, and the second valve also prevents the patients exhalationsfrom contaminating the operator. Valve 39 and its cooperating bellows40, it will be recognized, vent the patients system by opening ports 37and 38 at the proper time in the cycle. It will be likewise appreciatedthat during the operators exhalation the pressure developed on theright-hand side of diaphragm 42 insures the continued closure of valve39. Since bellows 40 and diaphragm 42 remain in the position shownduring this portion of the operators breathing cycle, there is noopportunity of any of the air dispelled by the operator passing into theatmosphere via the above ports. It will also be appreciated that eitherthe stiffness of bellows 40 or the loading of valve 39 can be selectedto establish the threshold pressure level Which must be overcome by theoperators inhalation and the patients exhalation to open valve 39. Thepaths over which the intake air, the air transferred to the patient andthe latters exhalation travel are shown by dashed arrows 43, 44 and 45,respectively.

One obvious advantage of the construction of FIG. 3 is that it providesa more direct path between the operator and the victim. It will beunderstood that the arrangement of FIG. 3 may be modified along thelines shown in FIG. 1, with the check valve and bellows being replacedby a piston and helical spring combination. By the same token, the checkvalve and bellows can be incorporated into the system of FIG. 1 toduplicate the venting function of the piston and spring just mentioned.

In FIG. 4 there is disclosed as in-line piston-type resuscitation devicewherein the operators and the patients mouthpiece sections 47 and 48 arein coaxial alignment with their inner ends coupled to a hollow,cylindrical section 49 of increased diameter. Accommodated within thelatter section is a piston 50 which is biased to approximately theposition shown by helical spring 51. One end of this spring abuts theinner surface 52 of the top wall of section 49, which wall also hasformed therein a central aperture 53. The other end of this spring fitswithin the head of piston 50 and abuts the inner surface thereof. Acheck valve 54 of the type hereinbefore described is mounted in thecenter of the piston head and opens only during the operatorsexhalation. A central aperture 55 formed in the bottom end wall ofsection 49 completes the air passageway between the operator and thevictim. It would be noted at this time that the diameter of piston 50 ismade larger than either aperture 55 or the patients mouthpiece section48. This selection of dimensions limits the downward travel of thepiston. Cylindrical section 49 is also vented by apertures 56 and 57formed in the side wall near the lower end thereof. The operatorsmouthpiece section 47 is again furnished With a check valve 58 and thisvalve, like those previously used in this line, opens only during theinhalation effort of the operator.

The operation of this modification is essentially as follows. Theoperator draws air into his respiratory system via valve 58 and, whiledoing so, is protected from any contamination because of the normallyclosed position of check valve 54 mounted in the piston head. When theoperator exhales, his discharge passes down his mouthpiece section 47,through aperture 53 into section 49 and then via check valve 54 andaperture 55 into the the patients mouthpiece section 48. During thistransfer period, the pressure built up within cylinder 49 forces piston50 downward to the limit of its travel so that it comes to rest againstthe inner surface of the lower end Wall of this section, still blockingthe exhaust ports 56 and 57. Since these ports remain closed, all of theoperators exhalation passes directly into the patients system. At thecompletion of this exhalation, the elastic recoil of the patients chestand lungs acts to discharge the air thus transferred out of the system.This discharge when it takes place maintains check valve 54 closed andaids in the displacement of piston 50 upward against the action of coilspring 51. It will be appreciated that at the start of this dischargethe operator prepares for the next air transfer operation by taking hisnext breath, the air entering his respiratory system via check Valve 58.Consequently, a negative pressure is again available for pulling piston50 away from its seat to open exhaust ports 56 and 57. This cooperationbetween the patients discharge and the operators inhalation, asmentioned previously, insures the proper venting of the apparatus andthe establishment of an expiratory airway for the patient. Here, too,there is no conflict or interference between the breathing action of thepatient when established and that of the operator, no possibility ofmutual contamination and no need for the operator to remove his mouthfrom his mouthpiece section to satisfy his own breathing demands. Thepaths over which the intake air, the transferred air and the exhaust airtravel are identified in this figure by dashed arrows 60, 61 and 62.

It would be mentioned in connection with this modification that if aloaded valve is employed as expiratory valve 54, coil spring 51 may beremoved from behind piston 50, particularly if the apparatus is used ina vertical position. If, as is the casein FIG. 4, a spring is used tohold piston 50 lightly against its seat, a loaded valve is notnecessary. [For increased versatility, a light spring and an unloaded,simple, flap-type valve is recommended.

Since the operators inspiratory effort exerts a negative pressuredirectly on the back of the piston rather than through a sensing tube,the piston, in this modification, is widely moved during this portion ofthe operators breathing cycle. Consequently, with a light spring, a lowresistance, expiratory pathway is provided for the patient or victim.

FIG. 5 schematically depicts an in-line, bellows-type device, generallysimilar in function to the apparatus illustrated in FIG. 4. However, inthis modification the enlarged cylindrical section 64 houses a bellows65 closed at its lower end by a check valve 66 of the type hereinbeforeidentified. Both of these components cooperate to control the transferof air between the operator and the victim and the venting of thelatters exhalations in the appropriate part of the cycle. Here, theupper end of bellows 65 is secured or rests against the inner surface ofthe upper end wall 67 of section 64. The lower end of this bellows, asjust mentioned, is effectively closed by diaphragm 68 of valve 66. Thisvalve, it will be appreciated, is mounted so as to open only during theexhalation effort of the operator. Normally, the lower end portion 69 ofbellows 65 contacts the boundary edge 70 of aperture 71 formed in thelower end wall 72 of section 64. During the operators exhalation effort,this contact is strengthened so that little, if any, of the air expelledreaches exhaust ports 73 and 74. It will be appreciated that FIG. 5illustrates that portion of the cycle during which the victimsexhalation is vented to the atmosphere. In this modification, like allof those previously described, the operators mouthpiece section 75 isfitted with its usual intake check valve 76. Since the operation of thismodification is believed obvious in view of what has been presentedhereinbefore, no further description of its performance will be given atthis point. However, it would be mentioned that the paths over which theintake air, the transfer air and the exhaust air travel are shown bydashed arrows 77, 78 and 79.

It would be pointed out in connection with the modification of FIG. 5that valve 66 may or may not be loaded. If this valve is not loaded,then, as shown in FIG. 5, bellows 65 should be constructed so that inits normal position its end rests lightly against its seat. If a loadedvalve is used, this bellows may float. The pressure required to seat thebellows in the latter case, however, must be less than the openingpressure of valve 66 so that it will seat before this valve opens.

The design of the in-line devices of FIGS. 4 and 5 can be somewhatsimplified by having the diameter of cylindrical sections 49 and 64conform to that of the operators and patients mouthpiece section. Inother words, all of the apparatus can be incorporated within a singlelength of cylindrical tubing. To provide the necessary retaining meansfor the upper end of the coil spring, the open end of the bellows andthe valve seats for the piston and closed end of the bellows, suitableinternal collars can be formed in this tubing at appropriate locations.Also in these in-line devices, the harder the operator expires thetighter the piston or bellows presses against its seat. Thus, there islittle possibility of any air leaking to the outside during the airtransfer period.

The devices of FIGS. 1 and 3 which employ the pressure-sensing tube tocontrol the venting of the patients expired breath can be simplified bymounting the air intake check valve in a wall portion of the operatorsmouthpiece section in accordance with the practice shown in FIGS. 4 and5. This would eliminate the need of a separate air intake line. Theoperators and patients mouthpiece sections could then be made from asingle, tubular member having only one arm extending therefrom foraccommodating the piston or bellows control venting valve. The secondcheck valve, the one controlling the air transfer between the operatorand the patient, would be connected across the tubular member betweenthe pressure-sensing tube and the horizontal arm serving as the exhaustline.

It would be pointed out in connection with the devices hereinbeforedescribed that the diameters of the various airways preferably should beabout five-eighths of an inch. Passageways of this size have negligibleresistance and a very small and compact system can be constructed. Sincethe relatively small leaks in the pressure-compensated expiratory valvesare of no consequence, the various pistons may be loosely fitted withintheir cylindrical sections. This reduces the friction in the system andat the same time lowers the cost of producing these devices.

It is also pointed out that a simple flap-like check valve can besubstituted for each of the molded valves 6, 15, 33, 34, 58 and 76without impairing the operation of the respective embodiments of theinvention. Conversely, a loaded, molded valve can be substituted for thenon loaded check valves 6, 15, 33, 34, 58 and 76.

While the various modifications hereinbefore discussed have beendescribed in connection with the socalled mouth-to-mouth resuscitationmethod, it will be appreciated that these devices can be used to sustainparalytic polio cases, for example, or patients requiring tracheotomytube ventilation. In such applications the operator can be replaced withan automatic device having the proper intake and discharge cycle. Theseresuscitation devices can also be used with pressure-compensatedaviation oxygen masks, or other masks, to ventilate the patient witheither air or oxygen, depending upon which mode is most advantageous.Either or both the rescuers and patients end of the device may be fittedwith a mask. Also, the small percentage of carbon dioxide present in theoperators expired breath is usually not objectionable and may bebeneficial under some circumstances.

Obviously many modifications and variations of the present invention arepossible in the light of the above teachings. It is therefore to beunderstood that within the scope of the appended claims the inventionmay b practiced otherwise than as specifically described.

What is claimed is:

1. Apparatus for use in mouth-to-mouth resuscitation comprising, incombination, a pair of tubular members cross-coupled to form a four-armtubular structure with successive arms corresponding to an air intakeline, an operators mouthpiece, an exhaust line, and a patientsmouthpiece, means positioned within said air intake line for blockingthe flow of air between the open end of said air intake line and saidoperators mouthpiece during the exhalation effort of an individual whosemouth is coupled to said operators mouthpiece and for permitting such aflow during the inhalation effort of said individual, means positionedat the intersection of said cross-coupled tubular members for blockingthe flow of air between said operators and said patients mouthpiecesduring the inhalation effort of said individual and for permitting sucha flow to take place during the exhalation effort of said individual andmeans associated with said exhaust line for maintaining said line closedduring the exhalation efforts of said individual and for opening saidexhaust line to the atmosphere in response to air discharged into saidpatients mouthpiece by said patient during said individuals inhalationefforts.

2. Apparatus for use in mouth-to-mouth resuscitation comprising, incombination, a first tubular member, sec- 0nd and third tubular memberscoupled to diametrically opposite wall portions of said first tubularmember at a location intermediate the ends thereof whereby a fourarmtubular structure is formed with said arms meeting in a commonintersection and corresponding to an air intake line, an operatorsmouthpiece, an exhaust line and a patients mouthpiece, valve meanspositioned within said air intake line for permitting the flow of airbetween the open end of said air intake line and said operatorsmouthpiece only during the inhalation effort of an individual whosemouth is coupled to said operators mouthpiece, valve means positioned atsaid common intersection for permitting the flow of air between saidoperators and said patients mouthpieces only during the exhalationeffort of said individual, and valve means associated with said exhaustline for maintaining said exhaust line closed during the exhalationefforts of said individual and for opening said exhaust line to theatmosphere in response to air discharged into said patients mouthpieceby said patient during the inhalation efforts of said individual wherebysaid patients respiratory system can be vented periodically to theatmosphere through said exhaust line.

3. Apparatus for use in mouth-to-mouth resuscitation comprising, atubular structure having first, second, third and fourth arms extendingfrom a common intersection with said first and third arms being inalignment and said second and fourth arms being in alignment, saidsecond arm being closed off at one end, a first check valve positionedacross opposite corners of said intersection and controlling the passageof air from one end of said first arm into said third arm, said checkvalve opening only when said pressure within said first arm is greaterthan that within said third arm, a second check valve positioned acrosssaid fourth arm, said second check valve opening to admit air into saidfirst arm only when the pressure within said first arm is less thanatmospheric pressure, a passageway intercoupling said first arm to saidsecond arm, said passageway entering said second arm at a point adjacentits closed end thereof, a third check valve mounted across said secondarm, said third check valve including a circular diaphragm, ventingports cut in the wall of said second arm between the location of saidthird check valve and said passageway, a circular bellows, one end ofsaid bellows being secured to a circumferential inner wall portion ofsaid second tubular arm between said passageway and said ports, theother end of said bellows being closed by the circular diaphragm of saidthird check valve.

4. Apparatus for use in mouth-to-mouth resuscitation comprising atubular structure having first, second, third and fourth arms extendingfrom a common intersection with said first and third arms being inalignment, said second arm being closed off at that end thereof which isremote from said common intersection, a first check valve positionedacross said fourth arm, said first check valve opening only when thepressure within said first arm is less than atmospheric pressure, asecond check valve positioned across two opposite corners of saidintersection, said second check valve opening only when the pressurewithin said first arm is greater than the pressure within said third armwhereby air dispelled from the respiratory system of an individualhaving said first arm in his mouth can pass directly into therespiratory system of a victim into whose mouth said third arm has beeninserted, venting ports cut through the wall of said second arm and apressure-compensated check valve mounted across said second arm betweensaid common intersection and said venting ports, saidpressure-compensated check valve being normally closed and remainingclosed when air is transferred from said first to said third arm andopening in response to air discharged into said third arm by said victimto permit his discharge to pass into said second arm, through saidventing ports and out into the atmosphere.

5. Apparatus for use in mouth-to-mouth resuscitation comprising atubular structure having first, second, third and fourth arms extendingfrom a common intersection with said first and third arms being inalignment, means for closing off said second arm at that end thereofwhich is remote from said common intersection, a first check valvepositioned across two diagonal corners of said intersection, saidcorners corresponding to those formed by the meeting of said first andsecond arms and said third and fourth arms, respectively, said firstcheck valve being normally closed and opening to permit the transfer ofair between said first and third arms when the pressure Within saidfirst arm is greater than the pressure within said third arm wherebywhenever said first and third arms are inserted into the mouth of arescuer and a victim, respectively, the rescuers discharge can passdirectly through said first check valve into the respiratory system ofsaid victim, a second check valve positioned across said fourth arm,said second check valve being normally closed and preventing airdischarged into said first arm by said rescuer from passing out into theatmosphere through said fourth arm but permitting air from saidatmosphere to be drawn into said first arm whenever the pressure withinsaid first arm is less that atmospheric whereby said rescuer can satisfyhis normal breathing requirements when said first arm is in his mouth bydrawing air from the atmosphere into his system through said secondcheck valve, venting ports cut in the wall of said second arm, and meansfor effectively blocking said venting ports whenever air is dischargedinto said first arm by said rescuer and for effectively opening saidventing ports whenever air is discharged into said third arm by saidvictim whereby said victims discharge can pass through said ventingports out into the atmosphere and cannot pass through said first checkvalve into the respiratory system of said rescuer.

6. Apparatus for use in mouth-to-mouth resuscitation comprising atubular structure having first, second, third and fourth arms extendingfrom a common intersection with said first and third arms being inalignment, means for closing off said second arm at that end thereofwhich is remote from said common intersection, a first check valvepositioned across two diagonal corners of said intersection, saidcorners corresponding to those formed by the meeting of said first andsecond arms and said third and fourth arms, respectively, said firstcheck valve being normally closed and opening to permit the transfer ofair between said first and third arms whenever the pressure within saidfirst arm is greater than the pressure within said third arm wherebywhenever said first and third arms are inserted into the mouth of arescuer and a victim, respectively, the rescuers discharge can passdirectly through said first check valve into the respiratory system ofsaid victim, a second check valve positioned across said fourth arm,said second check valve being normally closed and preventing airdischarged into said first arm by said rescuer from passing out into theatmosphere through said fourth arm but permitting air from saidatmosphre to be drawn into said first arm whenever the pressure withinsaid first arm is less than atmospheric whereby said rescuer can satisfyhis normal breathing requirements when said first arm is in his mouth bydrawing air from the atmosphere into his system through said secondcheck valve, a passageway interconnecting said first arm with saidsecond arm, said passageway entering said second arm at a point adjacentits closed end thereof, a third check valve mounted across said secondarm, said third check valve having as an air control component acircular diaphragm, venting ports cut through the wall of said secondarm at a location between said third check valve and the point at whichsaid passageway enters said second arm, a hollow circular bellows, onerim portion of said bellows being secured to a circumferential innerwall portion of said second tubular arm at a location between that pointwhereat said passageway enters into second arm and said venting ports,the other rim of said bellows contacting one side of said circulardiaphragm and being closed off thereby, said circular bellows preventingany air which is discharged into said first arm and that travels throughsaid passageway into said second arm from passing out into theatmosphere through said venting ports whereby a counterbalancing forceis applied to said one side of said circular diaphragm to oifset thatapplied to the other side thereof and to keep said third check valveclosed during the time air is being transferred from said first armthrough said first check valve and into said third arm.

References Cited by the Examiner UNITED STATES PATENTS 2,428,451 10/1947Emerson 12829 2,834,339 5/1958 Bennett 12829 2,887,105 5/1959 Brown128-29 2,902,992 9/1959 Renvall 12829 2,990,838 7/1961 Cross 128-293,063,620 11/1962 Black 128-29 X 3,099,985 8/1963 Wilson et a1 128293,124,124- 3/1964 Cross 128--29 FOREIGN PATENTS 1,204,930 8/1959 France.

875,790 8/1961 Great Britain.

RICHARD A. GAUDET, Primary Examiner.

1. APPARATUS FOR USE IN MOUTH-TO-MOUTH RESUSCITATION COMPRISING, INCOMBINATION, A PAIR OF TUBULAR MEMBERS CROSS-COUPLED TO FORM A FOUR-ARMTUBULAR STRUCTURE WITH SUCCESSIVE ARMS CORRESPONDING TO AN AIR INTAKELINE, AN OPERATOR''S MOUTHPIECE, AN EXHAUST LINE, AND A PATIENT''SMOUTHPIECE, MEANS POSITIONED WITHIN SAID AIR INTAKE LINE FOR BLOCKINGTHE FLOW OF AIR BETWEEN THE OPEN END OF SAID AIR INTAKE LINE AND SAIDOPERATOR''S MOUTHPIECE DURING THE EXHALATION EFFORT OF AN INDIVIDUALWHOSE MOUTH IS COUPLED TO SAID OPERATOR''S MOUTHPIECE AND FOR PERMITTINGSUCH A FLOW DURING THE INHALATION EFFORT OF SAID INDIVIDUAL, MEANSPOSITIONED AT THE INTERSECTION OF SAID CROSS-COUPLED TUBULAR MEMBERS FORBLOCKING THE FLOW OF AIR BETWEEN SAID OPERATOR''S AND SAID PATIENT''SMOUTHPIECE DURING THE INHALATION EFFORT OF SAID INDIVIDUAL AND FORPREMITTING SUCH A FLOW TO TAKE PLACE DURING THE EXHALATION EFFORT OFSAID INDIVIDUAL AND MEANS ASSOCIATED WITH SAID EXHAUST LINE FORMAINTAINING SAID LINE CLOSED DURING THE EXHALATION EFFORTS OF SAIDINDIVIDUAL AND FOR OPENING SAID EXHAUST LINE TO THE ATMOSPHERE INRESPONSE TO AIR DISCHARGED INTO SAID PATIENT''S MOUTHPIECE BY SAIDPATIENT DURING SAID INDIVIDUAL''S INHALATION EFFORTS.